Public Health and Mental Health

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Public Health and Mental Health

• A Model for Success

Grant Funded by Caring for Colorado Foundation
Presented by Cynthia Farkas, RNC, MS,
FNPJefferson County Department of Health
Environment 1801 19th Street, Golden CO
80401 August 25, 2003
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Jefferson County . . . Gateway to the Rockies

• Located west of metropolitan Denver
• Suburban, business, industrial, rural and
  mountainous communities
• Population of 529,401
• 95 Caucasian, 5 Other
• 10 Hispanic
• Median Income 57,339 yet a corridor of poverty
  is located along the eastern boundary of
  neighboring Denver County

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Jefferson County Department of Health and
EnvironmentPublic health . . . Everyday,
Everywhere, Everyone

• Established in 1959 as an organized health
  department serving all of Jefferson County
• One of 15 local health departments in Colorado
• Mission To create, promote and enhance health
  and vitality through innovation, collaboration
  and celebration
• 4 Divisions Community Health Services,
  Environmental Health, Health Promotion
• and Administration

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Public Health and Mental Health Program Mission
To address the mental health needs in the
population served by the JCDHE clinic, home
visitation and community outreach programs.

• Goals
• provide assessment and identification of mental
  health needs and barriers to services
• provide education and brief treatment (1-3
  sessions) to clients
• referrals and assistance for individuals and
  families who are in need of mental health
  intervention who are uninsured or underinsured
• provide education, training and consultation to
  JCDHE staff

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The Mental Health Program

• Unique public health/mental health model
  integrates into JCDHEs already existing
  community health services and programs that
  include nursing services, nutrition, and health
  promotion services
• Holistic, comprehensive strength-based model
  aimed at bridging the gap for clients to mental
  health services in a supportive,
  non-stigmatizing and accessible manner

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Addressing Community Need

• Created in response to communitys initial input
  regarding the need for services
• In the fall of 2000, JCDHE hosted several summits
  at various sites throughout the county to elicit
  community concerns and needs
• Public meetings hosted by Caring for Colorado
  Foundation and Coalition for the Medically
  Underserved
• Mental health was identified at all of the
  meetings as one of the major needs within the
  county that was not adequately addressed
• Continued reductions in funding have
  resulted in decreases in mental health
  services in the county

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Background

• January 2002, JCDHE awarded a grant from Caring
  for Colorado Foundation to develop mental health
  program within public health setting.
• A Psychiatric Clinical Nurse Specialist with a
  background in consultation liaison psychiatry was
  hired into a .5 FTE position in April of 2002.
• Initial budget of 43,535.00
• Role of JCDHE
• Grant writing
• Site of implementation
• Staff provides referrals to program
• Provide indirect costs

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How it Works

• Referrals are received from staff on clients in
  need of mental health assessment, referral,
  and/or brief intervention
•    Clients are seen in three clinic sites, at
  WIC appointments, and during home visits with or
  without the community health nurse
•    Telephone screening, intervention, and
  referral as needed

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Meeting the Needs of Clients

• Culturally diverse, high risk population
• Individuals and families experiencing a great
  deal of stress and crisis in their lives that
  affect their ability to utilize health services,
  improve health practices, and resolve health
  problems
• Reasons for referrals
• Depression/anxiety/postpartum depression
• Grief/loss/adjustment reactions
• Requiring assistance with referral/follow-up
  mental health care/psychotropic medication needs
• Family/marital issues
• Physical/sexual abuse
• Reactions to trauma/PTSD

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Meeting JCDHE Staff Needs

•   Staff Consultation
• increasing awareness of incidence and prevalence
  of mental health issues with JCDHE client
  population
• increasing skills to make assessments regarding
  the need for further mental health evaluation,
  treatment, and referral
• Monthly mental health consultation/staffings with
  CHNs, Nurse Family Partnership nurses, EPSDT
• Quarterly meetings with Clinic Nurses
• and WIC staff and as needed with other
• JCDHE groups/teams
•  

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Meeting JCDHE Staff Needs

• Monthly Mental Health Brown Bag In-services
• Depression and Suicide Assessment
• Differentiating Delirium, Dementia, Depression
• Therapeutic Communication
• Dealing with Difficult Clients
• Postpartum Disorders
• Bipolar Disorders
• Sexual Assault
• Anger and Conflict Management
• Staff benefits
• Increased work satisfaction
• Boundaries in a therapeutic relationship
• Self-care

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Barriers Encountered
Strategies to Overcome

• Lack of mental health services in community
  impending budget cuts
• Access to population that is resistive,
  suspicious, and negative regarding mental health
  services
• Obtaining feedback on referrals to community
  mental health services, as clients are transient
  and difficult to reach

• Mental health resource list liaison role of MHS
  attends Health Care Access Coalition
• MHS collaborates with nurses and other staff,
  e.g. joint office/home visits
• Nurse and other staff assist with follow-up of
  clients client satisfaction survey initiated
  collaborate with key partners

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Lessons Learned

• Integrating mental health into a public health
  setting works by reducing barriers to access
• Having an advanced practice nurse in the role of
  mental health specialist is effective

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First Year Accomplishments

• 87 client referrals 40 seen in home/office 47
  via phone encounter
• 109 staff consultations - 37 client, 24 staff,
  and 12 program issues
• 16 group consultations
• 24 educational classes at noon
• 62 community contacts
• Funded for a second year budget of 47,815
• Program evaluated positively by staff

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Next Steps

• Apply for a third year of funding
• Focus on outcome evaluation
• Explore continuation funding in light of the
  value of MHS has to staff and agency
• Continue to develop liaisons and partnerships
  with community agencies

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How to Reach Us

• Cynthia Farkas 303-239-7003
• cfarkas_at_jeffco.us
• Kelly Gaul..303-239-7022
• kgaul_at_jeffco.us